ACNM Structure and Function

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ACNM Structure and Function

Deanne R. Williams, CNM, MS, FACNM

Learning Objectives

2. Describe the ACNM organizational structure. 3. Identify the five ACNM divisions and their function.

4. Describe the mission and purpose of the ACNM Foundation. 5. Understand the function and format of the ACNM Annual Meeting. 6. Discuss the history of the Journal of Midwifery & Women’s Health.

Historical Roots

The American College of Nurse–Midwives is the professional membership organization for certified nurse–midwives (CNMs), certified midwives (CMs), and students enrolled in the ACNM Division of Accreditation accredited education programs.

Incorporated in 1955 as the American College of Nurse–Midwifery, ACNM changed its name in 1969 after it merged with the American Association of Nurse–Midwives (estab-lished in 1929). The creation of a single national organization to represent nurse–midwives places ACNM in the position of being the oldest women’s health organization in the United States. In the Journal of Midwifery & Women’s Health Special Issue: 50 Years of Nurse– Midwifery/Midwifery, Dawley (2005) outlines the quest for a new national organization for nurse–midwifery and the history of the development of the American College of Nurse–Midwives, and King (2005) tells the story of the ACNM seal.

The leaders who envisioned this organization understood the importance of setting na-tional standards for the education, certification, and practice of midwifery and promoting the interests of midwives. Although the organization’s foremothers explored a number of options that would have kept nurse–midwives within already established nursing organi-zations, it was their understanding of what was needed for professional autonomy that led to the decision to establish a separate organization. From fewer than 20 original members,

the organization has grown to over 7,000 members. Although membership is voluntary, a majority of midwives understand how much the organization has contributed to the pro-fessional reputation now enjoyed by CNMs and CMs. The initial vision of an autonomous profession, capable of defining the scope of practice for midwifery and striving for legal recognition in all 50 states, must have seemed quite daunting at the time. Yet 50 years later, CNMs are licensed to practice in all 50 states plus all territories and are recognized in many influential federal and state laws and regulations. Although most work as employees of hospitals, physicians, or clinics, many own their own business. The standards for the ed-ucation and certification of CMs, designed to be equivalent to the CNM, were adopted by ACNM in the late 1990s. Over 50 individuals have earned this credential, and licensure that recognizes the CM is available in three states.

As of 2006, the organization has set standards for the accreditation of nurse–midwifery, and then direct-entry midwifery, education programs for 44 years. The earliest nurse– midwives were certified based upon completion of their education program; however, for the past 34 years, ACNM has supported a national certification examination that is now implemented by an autonomous organization, the American Midwifery Certification Board, Inc. (formerly the ACNM Certification Council, Inc.). Over 10,000 graduates have passed the national certification exam.

Membership

All CNMs, CMs, student nurse–midwives (SNMs), and student midwives (SMs) are eligi-ble for membership in ACNM. The three classifications of membership are:

• Active: CNMs and CMs only; may hold office or appointments on divisions, com-mittees, and/or chapters

• Associate: CNM/CM who is a full-time student, engaged in missionary or volunteer work, retired, disabled, or not employed

• Student: Enrolled in an accredited or pre-accredited ACNM Division of Accreditation–approved nurse–midwifery or midwifery program or a graduate who is eligible to take the certification exam

ACNM members are eligible for all services of the national office, including technical assistance and consultation. Members are eligible to participate in the ACNM-endorsed professional liability insurance program, vote in elections, pay a reduced registration fee for the Annual Meeting, and receive subscriptions to the Journal of Midwifery & Women’s Healthand Quickening.

Governance

The ACNM Articles of Incorporation and Bylaws define the goals, objectives, and mission of the organization, how it conducts business, and its relationship to members. The most current version of these and many other documents referenced in this chapter are available on the ACNM Web site at www.acnm.org. ACNM is governed by a 10-member Board of Directors (Executive Committee plus six regional representatives). Board members are 42 CHAPTER2 ACNM STRUCTURE ANDFUNCTION

nominated by the Nominating Committee, elected by the membership, serve 3-year terms, and may serve two consecutive terms. Elections are staggered so board of directors (BOD) members’ terms expire at alternating times.

The BOD has the overall responsibility to meet the objectives of the college, set policy, manage the funds of the college, approve chairpersons of divisions and committees, and approve standards of practice. The BOD consists of the president, vice president, secretary, treasurer, and representatives from six regions. The BOD meets four times each year, and all members are welcome to observe open board meetings.

To conduct the work necessary to the college, the ACNM bylaws authorize five stand-ing divisions (Accreditation, Education, Research, Standards and Practice, and Women’s Health Policy and Leadership) and the Nominating Committee. The president, with ap-proval of the BOD, can establish specialized committees. With the exception of the Division of Accreditation and the Nominating Committee, all divisions and committees work with direction from the BOD. Members may serve on a Division or Committee for a 3-year term, limited to two consecutive terms for the same position.

ACNM Divisions

The Division of Accreditation (DOA), which is recognized by the U.S. Department of Education as an accrediting agency for nurse–midwifery education programs and direct-entry midwifery education programs for the non-nurse, has autonomous authority to plan, implement, and evaluate accreditation processes for nurse–midwifery and midwifery edu-cation programs. The DOA has a separate Board of Governors and an Advisory Committee. Refer to Chapter 4 for further information about the DOA and midwifery education.

The purpose of the Division of Education is to contribute to the health of women and newborns and the advancement of the profession of midwifery through the support and promotion of educational endeavors for and by certified nurse–midwives, certified mid-wives, and students in ACNM Division of Accreditation accredited programs. The DOE sections include: Basic Competency, Continuing Competency, Preceptor Development and Support, Continuing Education, and Policy.

The purpose of the Division of Research (DOR) is to contribute to knowledge about the health of women, infants, and their families and to advance the profession of midwifery by promoting the development, conduct, and dissemination of research. The DOR sections in-clude: Research Advisory, Research Development, Networking, International, and Data and Information Management. Refer to Chapter 13 for more information about midwifery research.

The purpose of the Division of Standards and Practice (DOSP) is to contribute to the health of women and infants and the advancement of the profession of midwifery by pro-viding, promoting, and supporting development and communication and review of mid-wifery philosophy, code of ethics, and standards and practice. The DOSP sections include: Clinical Practice and Structure, Home Birth, Quality Improvement, Professional Liability, and Business.

The purpose of the Division of Women’s Health Policy and Leadership (commonly known as the DOW) is to improve women’s health at the community, national, and

international levels through coordination of the development of public health and women’s health policy initiatives. The DOW sections include: Policy Development and Evaluation, Networking Development, Leadership, Women’s Health Issues and Projects, and Public Information. Refer to Chapter 15 for more information on women’s health and midwifery.

ACNM Committees

The purpose of the Archives committee is to establish, maintain, and preserve material of historical significance to the college for reference by members, midwifery students, and individual researchers approved by the BOD.

The purpose of the Bylaws committee is to facilitate the work of the ACNM and main-tain congruence with the bylaws of the college by review of the College Standing Rules of Procedure, Chapter Bylaws and Standing Rules of Procedure, proposed bylaw amend-ments, and other documents as requested by the ACNM BOD.

The purpose of the Government Affairs committee is to develop economic policies, to serve as a forum for policy coordination from the divisions, and to develop strategies to carry out the implementation of political and economic policies related to midwifery prac-tice and women’s health. In addition, the Government Affairs committee will coordinate the mobilization of grassroots efforts of the membership and implement appropriate strate-gies through political action.

The purpose of the Uniformed Services committee is to recruit and retain members of all active, retired, and reserve commissioned corps (Army, Navy, Air Force, and Public Health Service) to ACNM, provide representation for the needs of midwives working in federal facilities, and increase awareness among the college membership of the unique is-sues concerning uniformed service members.

The purpose of the International Health committee is to promote awareness and provide information on international maternal and child health-care issues for ACNM members.

The purpose of the Midwives of Color committee is to recruit and retain persons of di-verse ethnic and cultural backgrounds to the profession of midwifery; provide educational preparation to the ACNM membership, which will develop respect for cultural variations; and to increase awareness and responsiveness among ACNM membership to maternal/ child health-care issues affecting people of color.

The purpose of the Nominating committee is to ensure the conduct of legal and proper nominations of officers and other elective positions designated by the bylaws.

The purpose of the Program committee is to plan, help coordinate, and evaluate the ed-ucational content and business meetings for the annual meeting of the college.

The purpose of the Public Relations committee is to interpret to professionals and con-sumers the services provided by the college, components of maternal and child health (MCH) care, and the role of the certified nurse–midwife and certified midwife in the pro-vision of quality MCH care.

The purpose of the Student committee is to design and implement programs that sup-port and expand the contribution of students who are enrolled in ACNM DOA accredited education programs.

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ACNM Chapters

The ACNM bylaws authorize local groups of ACNM members within the same region to establish chapters. All authorized chapters must have their bylaws reviewed for compliance with ACNM bylaws, and are assigned a chapter number by the Bylaws committee. As of 2005, 98 ACNM chapters exist in the United States. Information on local chapters is avail-able in the ACNM Membership Directory, from regional representatives, and by contact-ing the national office staff.

Since 1992, the certification of CNMs and CMs has been the responsibility of a sepa-rately incorporated organization, the American Midwifery Certification Board, Inc. (for-merly the ACNM Certification Council, Inc.). Refer to Chapter 5 for more information on certification and licensure.

The National Office

The national office for the ACNM carries out the day-to-day activities of the college. Organized into four departments (Finance and Administration, Member Services, Professional Services, and Global Outreach), ACNM staff provide a wide range of exper-tise that contributes to the achievement of the organization’s objectives. In partnership with the Board of Directors, divisions, committees, and individual ACNM members, staff work in the areas of expansion of midwifery practice, policy analysis and advocacy, marketing and public relations, state and federal lobbying, international development, and imple-mentation of professional standards.

Finance and Administration

The finance and administration department is responsible for the ACNM budget and fi-nancial services.

Member Services

Member services responsibilities include a national marketing campaign; individual, chap-ter, and state-wide consultation and support for practice and legislative initiatives; publi-cation of a wide variety of professional and consumer edupubli-cation materials; organizing at least one national meeting each year; lobbying for initiatives that increase funding for mid-wifery education and practice and that improve the health status of women and their fam-ilies; and collaboration with other organizations on joint initiatives.

Professional Services

The professional services department provides essential services to ACNM members. The department is responsible for all aspects of clinical practice and policies. It has produced several sentinel publications, including the Quick Infoseries and articles on credentialing and professional liability. Professional services staff speak to large volumes of midwives

each year about issues that affect their clinical practice. The federal lobbyist, senior policy analyst (who addresses state policy issues), senior staff researcher, and senior technical ad-visor are members of the professional services department.

Global Outreach

For over 15 years, ACNM has worked on safe motherhood activities in developing coun-tries, primarily through the Department of Global Outreach (originally the Special Projects Section). It is widely known that the majority of women in resource-poor countries receive maternity care from midwives or traditional birth attendants. Saving the lives of women re-quires that all health-care providers have appropriate knowledge and skills, and this is par-ticularly true when hospitals are not available or are not capable of caring for women in labor. Hundreds of CNMs have worked as consultants in these countries, and ACNM has earned a solid reputation for providing expert consultants to establish the ACNM Life Saving Skills (LSS) program as a means to train skilled birth attendants. In 2005, ACNM introduced the Home-Based Life Saving Skills program, which is designed to complement LSS by making stronger connections and expanding the support from community organi-zations and leaders.

The ACNM Journal

The professional reputation of CNMs and CMs is enhanced by the publication of the peer reviewed Journal of Midwifery & Women’s Health, which is available online and listed in the Index Medicus. Established in 1955 as the Bulletin of the American College of Nurse– Midwifery, the name was changed in 1973 to the Journal of Nurse–Midwifery. In January 2000, the name was changed again to Journal of Midwifery & Women’s Health (JMWH). The history of the journal is well documented in the March/April 2005 issue of JMWH. The article by Editor Emeritus Mary Ann Shah, CNM, MSN, FACNM, includes a review of the 10-year effort that preceded the 1986 acceptance into Index Medicus; the provision of intensive home study programs by and for midwives; the movement to an independent editorial board; and a number of publication milestones that have distinguished this inter-nationally known journal.

The ACNM Foundation

Established in 1967, the ACNM Foundation, Inc. (ACNMF) is a 501(c)(3) nonprofit or-ganization that supports the provision of high quality maternal, newborn, and well-woman health services through the practice of midwifery. The foundation collaborates closely with and complements the goals of the ACNM. Donations to the foundation are tax deductible as allowed by law. Guided by the Board of Trustees, ACNMF engages in a broad program of activities, including provision of scholarships for basic midwifery students and re-search; sponsorship of research, educational, and leadership programs; and recognition of accomplished midwives. On average, the foundation gives out over $20,000 in awards and scholarships each year.

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Communication

ACNM communicates with members and the community at large through a number of mechanisms. Regional representatives utilize eMidwife discussion lists to post announce-ments and gather information. eMidwife discussion lists have been organized around top-ics such as clinical management, home birth, business, international, and gynecology. Members have the opportunity to share information and seek helpful hints on common dilemmas via these electronic communication tools. Members join a list via a link on the ACNM home page at www.acnm.org.

The bimonthly newsletter, Quickening, and professional journal, JMWH, are mailed to members and friends of the college. Quickeningis often described as a news journal. With timely information that goes into detail beyond what is typically found in a newsletter, Quickeningincludes regular columns from the president, executive director, regional rep-resentatives, director of professional services, policy staff, and the communication man-ager. Minutes from ACNM board meetings are published in Quickening along with information about new products and policies that impact women’s health and the practice of midwifery. Classified ads list jobs, products, services, and meetings that are relevant to the profession. Table 2–1lists ACNM publications.

Since 1994, ACNM has owned the Internet domains www.midwife.org and www.acnm.org. The Web site gets over 3,000 visitors per day and has been highly praised by students, midwives, members of the press, and consumers. Over the years, content on the Web site has expanded to include a large variety of announcements, current documents, and historical facts. Individuals can submit abstracts and register for ACNM meetings, pur-chase publications, write letters to elected officials and the media, apply for scholarships,

Table 2–1 ACNM Publications

Handbooks

Quality Management

The Midwife as First Assistant

Vacuum Assisted Birth in Midwifery Practice Home Birth Practice

Clinical Privileges & Credentialing

Minding Your Own Business: Business Plans for Midwifery Practices Getting Paid: Billing, Coding and Payment for Nurse–Midwifery Services Marketing and Public Relations

Taking Action: A State Advocacy Handbook

Midwifery Today: A Summary of Nurse–Midwifery Legislation Marketing Materials

Pregnancy Calculator

Today’s Certified Nurse–Midwife Brochures Certified Nurse–Midwives and Your GYN Health Bimonthly News Journal

Quickening Journal

communicate with ACNM staff members, apply for membership, and make a donation to the foundation all via the ACNM Web site.

The ACNM Annual Meeting and Exhibit, which is scheduled in the spring of every year, attracts more than 1200 midwives to five days of meetings that include continuing educa-tion sessions, business meetings, an exhibit hall, and fundraising for the ACNM Foundation. A wide variety of education sessions and workshops are offered to meet the continuing education needs of midwives. In addition, a number of official and unofficial activities are planned that facilitate interaction between members and the ACNM leader-ship. All divisions and committees meet during the week and the members conduct the business of the College as defined in the bylaws. This is the only time when the organiza-tion’s bylaws can be changed and members can bring motions to the floor for discussion and an advisory vote by those present. The Annual Meeting is an important mechanism for communicating the state of the profession to a variety of colleagues and serves as an im-portant opportunity for midwives to expand their knowledge, scope of support, and pro-fessional pride. Special activities, such as breakfast with the BOD and preparation of a student report to the membership, are designed to introduce midwife students to the pro-fession. Activities such as the Heart of Midwifery, Blankets for Babies, and the closing party offer attendees a chance to go beyond the scientific boundaries to the heart of what binds the profession together (Box 2–1).

ACNM also publishes a number of handbooks, guidelines, reference packets, and mar-keting materials designed to meet the needs of midwives that are available to purchase on-line. Many ACNM documents can be downloaded without charge.

MidwifeJobs.com (www.midwifejobs.com) is the only online job search site dedicated to matching midwives with employers who are seeking the services of a midwife. Members can post their resumes online and can sign up to receive notification of any new 48 CHAPTER2 ACNM STRUCTURE ANDFUNCTION

Box 2–1 In the Words of a Student

Having attended the ACNM Annual Meeting 2 years in a row as a student I must say that what I have come away with both years is a greater understanding and awareness of the “culture” of the profession. I believe it is important for the organization to gather like this on a consistent basis since the density of midwives throughout the country is not very high. If we did not come together in such ways we would slowly become absorbed by the healthcare system and lose our identity in the process. There’s strength in numbers as we all know, so maintaining a strong, unified organization is crucial to the advancement of any profession. You should know that each year is different, and heavily dependent upon the location where the conference is held. Last year, it was New Orleans; we stayed 2 blocks off Bourbon Street. Needless to say, it was a much different atmosphere than this year’s politically fo-cused meeting. Last year there was a palpable energy in the lobby of the hotel where we stayed, mainly due to the nightlife that everyone was enjoying. This year, the same amount of energy was present, but focused on Capitol Hill. I appreciate both types of agendas, mak-ing friends and makmak-ing political progress.

Hope to see you next year!

Samantha Nardella Kansas University Medical Center © Jones and Bartlett Publishers. NOT FOR SALE OR DISTRIBUTION

job postings. Listings are organized geographically. Like virtually all ACNM services, the success of any one program is a direct measure of how many members chose to partici-pate. MidwifeJobs.com receives high marks from those looking to hire a midwife!

ACNM also supports three consumer-focused Web sites: www.gotmom.org, www.myMidwife.org, and www.withwomen.org. GotMom provides breastfeeding infor-mation and resources to mothers and families; myMidwife provides inforinfor-mation on mid-wifery, maternity, women’s health, and family-centered health care; WithWomen introduces the ACNM education campaign designed to create a virtual network of health care organizations that believe women count and are working to improve the lives of women and their families. ACNM has also published four editions of the consumer maga-zine, Every Baby. Over 250,000 copies are available for distribution by members each year.

ACNM Honors and Awards

The ACNM Fellowship program was established in 1994. Election to ACNM Fellowship is an honor that is celebrated at each ACNM Annual Meeting. Fellows earn the credential based on their professional achievement, outstanding scholarship, clinical excellence, and/or leadership. The mission of the Fellowship is to serve the ACNM in a consultative and advisory capacity.

First awarded in 1997, the Hattie Hemschemeyer Award is bestowed annually to an out-standing ACNM member who is a CNM/CM, has been certified for at least 10 years, and has demonstrated outstanding contributions or distinguished service to midwifery or ma-ternal child heath. The award is named after the first ACNM president. The Kitty Ernst Award, affectionately named the “young whippersnapper” award, is named after the youngest ACNM president, known for her flamboyant hats and purple boa. The Kitty Ernst award honors a CNM/CM who is an active ACNM member and has been certified for less than 10 years. The award is presented annually to an individual who has demonstrated in-novative, creative endeavors in midwifery and/or women’s health clinical practice, educa-tion, administraeduca-tion, or research.

Other awards presented at the ACNM Annual Meeting include the Regional Award for Excellence, which honors one CNM/CM from each region during the regional meetings. The recipients of this award are elected by members within each individual region. The Dorothea M. Lang Pioneer Award is named after an ACNM president and visionary leader, and honors an exceptional CNM/CM who has been certified for 10 years, has not received the Hattie Hemschemeyer Award, and demonstrates vision and leadership. The With Women for a Lifetime commendation honors midwifery services, and the Midwifing Midwives for a Lifetime commendation honors midwifery education programs that have provided inno-vative and compassionate care to families, expanded access to women’s health care to CNMs/CMs, and educated future CNMs/CMs.

Support for Students

ACNM has designed a number of programs with the student in mind. From membership dues to the annual meeting registration, deep discounts are offered to students. Students

are welcome to serve on divisions and committees, speak at the business meetings, and participate in the annual preparation of a report for the membership on the needs of stu-dents. Many ACNM publications focus on the business of midwifery because this is an area that is hard to fit into most education programs, but becomes critically important shortly after graduation. ACNM provides expert consultation for midwives who need to apply for hospital privileges and need to be credentialed by health insurance companies. Student members can post their resume on MidwifeJobs.com for free, and ACNM offers a certification exam prep course at the Annual Meeting. A student-only breakfast with the ACNM Board of Directors is scheduled during the Annual Meeting. Students are welcome to serve as interns at the ACNM national office. In addition, the ACNM Foundation awards a number of student scholarships each year.

Summary

Fifty years after its incorporation as an independent voice for the profession of nurse– midwifery, ACNM has surpassed the vision of its founders. Now representing certified nurse–midwives and certified midwives, ACNM is well-known and widely respected for the role it plays in promoting the health of women and newborns throughout the world. All CNMs and CMs, whether members or not, are well served by the role ACNM plays in a wide variety of areas. Whether it is assuring that laws, regulations, and policies that influ-ence access to women’s health care are midwife-friendly, creating a demand for midwifery care, educating members on the business of midwifery, or doing the hard work that comes with being a professional, ACNM members and staff have always been up to the task.

References

Dawley, K. (2005). Doubling back over roads once traveled: Creating a national organization for nurse– midwifery. Journal of Midwifery & Women’s Health, 50(2), 71–82.

King, T. (2005). The emblem of the American College of Nurse–Midwives. Journal of Midwifery & Women’s Health, 50(2), 83–84.

Shah, M. A. (2005). The Journal of Midwifery and Women’s Health1995–2005: Its historic milestones and evolutionary changes. Journal of Midwifery & Women’s Health, 50(2), 159–168.

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Table 2–2 For Your Professional Files ACNM Articles of Incorporation ACNM Bylaws

ACNM Mission Statement

ACNM Philosophy and Code of Ethics